Medicaid Bait and Switch

Blog#164- 7/12/23

Richard Davis

One of the best things that happened as a result of the COVID pandemic was the rules relaxation and resulting expansion of this country’s Medicaid program. There also were a number of other factors that contributed to a major increase in Medicaid enrollment. The bottom line is that this country finally started to move in the right direction with its Medicaid program.

According to the National Library of Medicine, “From 2017 to 2019, national Medicaid enrollment declined by 2.6%. The COVID-19 pandemic reversed this course abruptly, with Medicaid enrollment increasing by 15.5% from February 2020 relative to April 2021. While existing research points to massive job loss as one primary driver of this increased enrollment, this study found that approximately three-fourths of Medicaid enrollment growth could be traced to declines in the rate of disenrollment relative to 2019, with only one quarter explained by higher rates of new enrollment during the March to October study period.”

There was a national relaxation of the rules for renewing enrollment in Medicaid programs and the number of people who usually lose benefits decreased dramatically. It was called the Continuous Enrollment Period. Total Vermont Medicaid enrollment had grown to more than 192,000 as of late 2022. That was a 19% increase from 2013, due primarily to the COVID pandemic and the resulting pause on eligibility redeterminations nationwide.

The national uninsurance rate dropped to an all-time low in 2023 and it looked as if this country was finally learning how to move in the right direction with some degree of health care reform. Medicaid enrollment grew by 20 million and it was starting to look like a lot of people would finally have affordable access to health care.

But as the pandemic has been officially declared over the relaxation of Medicaid enrollment rules is ending in many states and the number of people being thrown off the program is staggering. The Continuous Enrollment Period is over and states such as Florida and Texas are happy to remove millions of people from their Medicaid roles. They will never consider the fact that trying to keep the Medicaid roles at pandemic levels would save a lot of lives and a lot of money.

Governor such as Abbott and DeSantis only see lazy people who are feeding at the welfare trough and they are putting their political ideology in service of their campaigns to bolster their image among the MAGA Republicans.

According to the Kaiser Family Foundation, between eight and 24 million people could lose Medicaid coverage as the Continuous Enrollment Period ends. These people will once again have to navigate their states byzantine bureaucracy to maintain Medicaid enrollment.

Kaiser estimates indicate that in Vermont 30,000 adults and 8,000 children will most likely lose their Medicaid coverage. They note that, “Expected disenrollments during the unwinding could reverse more than half of the Medicaid enrollment gains experienced during the continuous enrollment period. Comparing the number of estimated enrollment growth during the continuous enrollment period, shows that the number of people losing Medicaid coverage would be nearly three-quarters of the enrollment increase under the midpoint scenario. Under this midpoint scenario, just over one-quarter of the enrollment increase during the pandemic would persist, meaning Medicaid coverage would be higher than pre-pandemic levels. The higher-range estimate of Medicaid coverage loss—which is not expected to occur in most states—suggests that in some states, Medicaid disenrollments during the 14-month unwinding period could exceed the enrollment gains from the 3-year continuous enrollment period. In some states, the number of people losing Medicaid could exceed the coverage gains because all current Medicaid enrollees will have to go through a renewal process.”

Some good (very little) may come out of all of this enrollment mess. Why don’t we hear national politicians talking more about this inhumane change in the Medicaid program?

It probably has something to do with the fact that election rhetoric is heating up and no one wants to look sympathetic to the more vulnerable among us because they could lose too many votes.

If they thought a large percentage of Medicaid enrollees voted the issue might be getting more attention. Politicians on the left and the right are staying silent on this, for the most part. Silence is tantamount to suffering and death.

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